Transcatheter Heart Valve Implantation (TAVI)

What Is Transcatheter Heart Valve Implantation (TAVI)?

A transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve replacement implantation (TAVI) is a minimally-invasive procedure for individuals with severe aortic stenosis.

Aortic stenosis (AS) refers to a narrowing of the aortic valve opening which restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium. Aortic stenosis may not result in many symptoms until blood flow is severely restricted which may lead to symptoms such as:

• Chest pain
• Rapid heart beat 
• Shortness of breath
• Fainting spells
• Swollen ankles of feet
• Sudden cardiac death

If left untreated, the survival rate for patients suffering from severe aortic stenosis is only at 50% within 2 years.

Usually, a heart valve surgery requires an open heart procedure involving sternotomy, in which a vertical inline incision is made in the middle of the chest at the breastbone (sternum) to provide access to the chest cavity.

A TAVR or TAVI allows an aortic valve to be implanted using a long thin and flexible tube (catheter) through very small incision made in the groin that leaves all the chest bones in place. A minimally invasive heart surgery like TAVI may involve a shorter hospital stay, quicker recovery and less pain than traditional open heart surgery.

Why Do You Need TAVI?

TAVR / TAVI may be an option for individuals who have severe aortic stenosis (AS) and are at intermediate risk for surgery, at high risk for surgery, or who are not suitable for open heart surgery. The procedure aims to ease the symptoms caused by aortic stenosis and improve life span.

Open heart surgery to replace the aortic valve is conventionally used to treat severe aortic stenosis. However, the surgical risks are often high, especially for elderly patients and those suffering from conditions that would increase their risk for open heart surgery.

Factors making TAVI more likely to be recommended include:

• Your age
• Your overall health 
• Your heart function
• Past medical history of heart surgery or stroke
• Other medical condition such as COPD, liver disease, kidney disease and diabetes

What To Expect In A Transcatheter Aortic Valve Implantation (TAVI)?

Discuss with your doctor if you have any questions regarding the procedure.

During A TAVI Procedure

During a TAVI, a small incision is made near the groin. Next, a guiding catheter (a thin and flexible tube) is inserted to implant the aortic valve, using the following steps.

To prepare for surgery, you will need to undergo several tests to check that you are healthy enough to proceed with the operation. This may include:

• X-rays and other imaging scans
• Blood tests to determine the health of your heart and lungs
• Echocardiogram to evaluate the function of your aortic valve
• Cardiac catheterisation to evaluate the arteries supplying blood to the heart.

Step 1: Balloon Valvuloplasty

Guided by a catheter, an inflatable balloon is first inserted into your aorta to open up the heart valve.

Step 2: Aortic Arch Navigation

The transcatheter heart valve is guided through your artery into your heart.

Step 3: Native Valve Crossing

The artificial valve is placed in position in preparation for deployment.

Step 4: Deployment

The inflatable balloon is used to deploy and lock the valve in place. There are also other TAVR / TAVI valves that are self-expanding and do not need a balloon for deployment.

Step 5: Final Assessment

The catheter is removed and the new valve is now working in place of the original diseased valve.

After a TAVI procedure

Following the procedure, you may have to spend 2 – 4 days recovering in the hospital, which may include a period of observation at the intensive care unit (ICU), before you can be discharged.

Recovery period for a TAVI procedure

Complete recovery may take several weeks and varies depending on your health. During this time, it is important to care for the incision site carefully to prevent infection and take any medication that has been prescribed. You should also walk around as much as possible but avoid heavy lifting or strenuous activity.

Follow your doctor’s advice on when you can resume normal daily activities such as driving or going back to work. Cardiac rehabilitation may be recommended to help improve exercise tolerance, functional capacity, and quality of life.

Your doctor may recommend that you make healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and avoiding smoking.